1. What drove your decision to choose the specialty
of ophthalmology and the subspecialty of
retina?
I was a third-year medical student when I chose a
month-long externship with Bruce E. Spivey, MD, in
ophthalmology at the Pacific Medical Center in San
Francisco. I made this decision
because, frankly, I wanted to see
San Francisco. It was during that
month, however, that I fell in love
with ophthalmology.

My next step was an internship
at Highland General Hospital in
Oakland, CA, because I wanted to
put all the things I learned in medical
school together before focusing
on a single specialty. There I experienced
everything from delivering
newborns to tending to patients
with gunshot wounds—it was an exciting year.

When I entered into my ophthalmology residency
at Pacific Medical Center, I met and worked with
three individuals who had significant impacts on
my future: medical retina specialist John Cavendar,
MD, and retina surgeons Wayne E. Fung, MD, and
George Hilton, MD. These three gentlemen lit my
retina fire, so to speak.

2. Since your involvement in the pneumatic
retinopexy trial early in your career as a retina
specialist, you have been at the forefront of many
surgical and medical developments. What do you
consider most exciting?
I think the biggest breakthrough in my career has
been the ability to treat macular holes, although to
this day I don’t understand why patients are forced
to be positioned face down. Next, our surgical
instruments and techniques have evolved significantly
in terms of refinement and reliability. In the
early days of vitrectomy surgery, you never knew if
your instruments were going to last for an entire
case. Our vitrectomy cutters were reusable (and
very expensive) and had to sent to Switzerland to be sharpened—there was far more OR hassle then.
Recently developed surgical tools, such as the wideangle
binocular indirect microscope, perfluorocarbon
liquids, triamcinolone acetonide and other
dyes for staining and visualization, have made surgery
much easier and have improved our outcomes.
Of course, spectral domain optical
coherence tomography and digital
photography have changed our
approach to many surgical and medical
diseases.

On the medical side of retina, we
are moving quickly toward the pharmacologic
manipulation of disease,
which is revolutionizing how we
treat patients.

3. How would you describe your
approach to treating your patients
and medicine in general?

When I completed medical school, I remember my
father, who also was a physician, offering the following
advice: Always do what’s best for the patient, and
everything else will follow. For every patient I treat, I
ask myself what decision I would make if the person
were my father, my mother, or my child. With this
approach, surgical decision-making is simple.

Regarding the direction of medicine in general, I am
very concerned. Many of my colleagues, including myself,
are not encouraging their children to go into medicine,
which says a lot about how doctors feel about the course
medicine is taking. It will always be a rewarding and satisfying
profession, but it takes 14 years after high school to
become a retina specialist, and a lot of personal sacrifice.
At the end of that long road is a system that takes for
granted the wonderful skills we have acquired. I knew we
were in trouble when we began to be called (and accepted)
the title of “provider” instead of “doctor.”

4. How have the roles of specialty groups such as the
American Society of Retina Specialists (ASRS)
evolved with the subspecialty?
When the ASRS (formerly the Vitreous Society) was
formed, the goal was to have an open society permitting
anyone trained in retina to share his or her ideas
in a relaxed collegial environment. We felt all our members
had something to contribute. The pluralistic
nature of the society and the exponential growth of
our membership have, in my opinion, resulted in the
ASRS being considered the political voice of retina.
Unfortunately, our growth has forced us to trade a
“one-on-one meeting” philosophy for a large “subspecialty
day” type meeting. As an alternative, I have tried
to fashion the International Masters of Retina meeting
along the lines of the old Vitreous Society.

Looking ahead, the ASRS will be required to apply this
leadership position to some of the pressing issues in retina,
which in my opinion are accreditation (of programs)
and certification (of fellows). First, we need to work with
government officials to redefine what a retina fellowship
is, so that teaching programs are compensated fairly for
training high-quality retina specialists. Once the training
programs are accredited, their graduates can be certified
(boarded). As things stand today, any ophthalmologist
can profess to be a retina specialist and can even train
fellows! It really is a public health issue.

5. Where might one find you when you are not in
clinic or teaching students?
When I was an undergraduate, I wanted to play professional
golf. I played on the golf team at Colgate, but
when we traveled to the South for golf matches, I realized
that most of these guys from Sunbelt states were
far above my level of play. I still enjoy the game, so I
suppose if I am not working you can find me at the
country club practicing. Usually I don’t have the time
to play entire rounds, but I like to practice every
chance I get. It clears my mind.

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About Retina Today

Retina Today is a publication that delivers the latest research and clinical developments from areas such as medical retina, retinal surgery, vitreous, diabetes, retinal imaging, posterior segment oncology and ocular trauma. Each issue provides insight from well-respected specialists on cutting-edge therapies and surgical techniques that are currently in use and on the horizon.